Provider Demographics
NPI:1033437561
Name:WHITE COUNTY CHILDREN'S SAFETY CENTER, INC.
Entity Type:Organization
Organization Name:WHITE COUNTY CHILDREN'S SAFETY CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/CHILD ADVOCATE
Authorized Official - Prefix:MR
Authorized Official - First Name:OLIVIA
Authorized Official - Middle Name:M
Authorized Official - Last Name:HAWKINS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:501-388-1636
Mailing Address - Street 1:PO BOX 2142
Mailing Address - Street 2:
Mailing Address - City:SEARCY
Mailing Address - State:AR
Mailing Address - Zip Code:72145-2142
Mailing Address - Country:US
Mailing Address - Phone:501-388-1636
Mailing Address - Fax:501-268-4748
Practice Address - Street 1:501 E RACE AVE
Practice Address - Street 2:
Practice Address - City:SEARCY
Practice Address - State:AR
Practice Address - Zip Code:72143-4416
Practice Address - Country:US
Practice Address - Phone:501-388-1636
Practice Address - Fax:501-268-4748
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-07
Last Update Date:2010-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251K00000XAgenciesPublic Health or Welfare
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR162273001Medicaid
ARE 4884OtherAR STATE LICENSE
AR162273001Medicaid